title: A nationwide survey of antimicrobial stewardship practices.
abstract: OBJECTIVE
  The goal of this study was to characterize hospital antimicrobial stewardship practices nationwide and to identify factors associated with the presence of these programs.
  
  
  METHODS
  The first web-based survey was sent in 2009 to members of the Yankee Alliance and the Premier Healthcare Alliance, nationwide organizations of health-care providers. The second survey, a slightly modified version of the first, was sent in 2010 to a commercially purchased list of hospital pharmacy director e-mail addresses.
  
  
  RESULTS
  A total of 406 responses were received from ~5890 providers targeted, for an overall response rate of ~7%. More than one half (206 of 406) of the respondents reported having what they considered to be a formal antimicrobial stewardship program (ASP). Among all respondents regardless of presence or absence of an ASP, 96.4% (351 of 364) were using some form of antimicrobial stewardship technique. Of those respondents working in hospitals without an ASP, 63.3% (114 of 180) had considered implementing one. After controlling for all significant variables, those that remained which were significantly associated with having an ASP were survey (Premier vs commercial), having an infectious disease consultation service, and having an infectious disease pharmacist.
  
  
  CONCLUSIONS
  In this survey of 406 respondents from across the country, we found that just more than one half of hospitals had what they considered to be formal ASPs; however, the vast majority were using stewardship techniques to optimize the use of antibiotics. Common barriers to implementation of ASPs included staffing constraints and insufficient funding.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA 02111, USA. sdoron@tuftsmedicalcenter.org
authors.forename: Shira
authors.initials: S
authors.lastname: Doron
authors.forename: Lauren
authors.initials: L
authors.lastname: Nadkarni
authors.forename: Lori
authors.initials: L
authors.lastname: Lyn Price
authors.forename: Pharmd
authors.initials: P
authors.lastname: Kenneth Lawrence
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Davidson
authors.forename: Jack
authors.initials: J
authors.lastname: Evans
authors.forename: Caren
authors.initials: C
authors.lastname: Garber
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy; D017723:Drug Utilization Review; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D010595:Pharmacists; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents